Chronic care management platform refers to a software solution that facilitates the coordination, documentation, and billing of chronic care provided by healthcare providers to patients with two or more chronic illnesses. It brings together care plans, patient management outside of face-to-face interactions, and specialists, staff and patients in one workflow. In such a system, it is no longer an optional infrastructure for practices that treat diabetes, hypertension, COPD and heart failure patients from an increasingly broad base of clients.
Most practices that do not have a dedicated Chronic Care Management Platform end up tracking CCM time on spreadsheets or sticky notes, which are unlikely to pass a CMS audit. The remainder of this piece covers the workings of these platforms, what to look for, and what many implementations get wrong.
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The Operation of a Chronic Care Management Platform
The platform, at its base, records all care team patient interactions outside of the scheduled visits and assigns them a time to match a specific CPT code. This is important because CCM is time based, unlike most primary care billing, which is visit based, CMS reimbursement is time based.
The typical workflow is as follows:
- CMS requires documented consent before any billing takes place and a patient with two or more chronic conditions is enrolled.
- Care staff enter the time spent on medication management, lab follow-up or a coordination call directly in the platform.
- The system provides a summary of the time spent by clinical staff each month, by the appropriate CPT code, typically 99490 (first 20 minutes of clinical staff time).
- Add-on codes including 99439 are used for more time increments, and codes 99487 and 99489 may be used for more complex cases.
- It generates an auto-filled report for claims and marks any patient that didn’t meet the number of minutes for that billing cycle.
It’s easy to see that a patient enrolled in CCM who only tracks 14 minutes in a given month can’t be billed under 99490, and most spreadsheet tracking systems won’t identify that until after the claim is denied.
Tracking Time And Billing Accuracy
Until you consider the auditing aspect, time tracking may seem like a minor feature. CMS and its contractors have identified CCM billing on a number of occasions as lacking the proper amount of time documentation, and it’s not 20 minutes total. Must be 20 minutes of qualifying clinical staff activity related to a documented care plan in one calendar month.
A good platform will automatically categorize billable activity from non-billable administrative tasks, you don’t have to have staff manually classify each entry. This is where many practices go wrong: a nurse spending 15 minutes on a patient updating their insurance information is not as much CCM work as it is simply “managing” the patient’s care. The ones that do this right create prompts based on the activity type, rather than having to guess what staff should add.
Being Able To Coordinate Care Between Providers
A diabetic patient with heart failure may visit an endocrinologist, a cardiologist and a primary care doctor, who don’t necessarily share each other’s records. Chronic care management (CCM) platforms should fill that void by providing all providers involved in a patient’s care with access to the same care plan and any changes.
In reality, this will only be effective if the platform allows for true interoperability and not a closed system in which PDFs must be exported manually. Seek integration with the practice’s current EHR, as opposed to having to keep two sets of records.
Key Features To Consider In A Chronic Care Management Platform
The following features set a platform aside that will save time for staff rather than be one more platform to manage.
- Patient eligibility checks should be automatic. Diagnosis code should be used to identify patient eligibility instead of manual chart review.
- Documented patient consent built in: CMS mandates that patient consent be documented, and this is a typical audit red flag.
- Diabetes care plans and COPD care plans are different; care plan templates save clinical time without compromising personalization.
- Reporting to the revenue cycle teams: Billing personnel don’t need a raw activity log to decipher; they need to know which patients are making their threshold each month.
Some Of The Mistakes They Make When Selecting One
While patient engagement is important, so is the financial viability of a CCM program, which is more dependent on claims paid and claims documentation passing inspection. Practices based on the wrong feature set often end up running two systems in parallel in a year.
An error on the other side is under-staffing. While a platform can automate documentation, the calls for coordination and logging the encounters have to happen. Enrollment rates in practices that rely on software alone to produce CCM revenue usually fall short of patient eligibility in their panel.
Why The Design Of The Platform Should Be Influenced By The Reimbursement Structure
One factor that is not often talked about outside of the billing landscape is that CMS changes CCM-related codes and reimbursement rates in the annual Physician Fee Schedule, which is also the time that a platform’s coding logic must be updated, not just when it is set up. Without a means to update the CPT codes on a platform each year, claims will be denied against outmoded rules over time. A vendor should be able to tell you how quickly the coding logic in their version of the CMS reflects changes in the annual fee schedule, and who tests that change prior to live claims.
The Bottom Line
A chronic care management platform is worth the price in making care coordination that is already informal documented, billable and auditable. The most effective platforms include accurate time tracking with the ability to integrate with EHRs, along with coding logic that remains up to date with CMS regulations, instead of CCM being a simple checkbox option on top of a full care management platform.
Tellihealth was designed to address the documentation and billing accuracy issues which are key drivers of underperformance in most CCM programs. Practices that adopt Tellihealth benefit from automated time tracking that is directly tied to the proper CPT codes, consent/eligibility tracking embedded in patient enrollment, and reporting that revenue cycle teams can easily act on without having to translate raw activity logs.
FAQs
What are the differences between chronic care management and remote patient monitoring?
Chronic care management (which is coded as 99490) are activities that are not face-to-face (as in the case of medication management or care planning). Physiological data like blood pressure or glucose levels can be collected by attached devices and are classified as remote patient monitoring (RPM) and follow a different set of CPT codes.
How many chronic conditions do you need for CCM?
CMS is required to indicate at least two chronic conditions that are likely to be present for at least 12 months or until the patient’s death, and which pose a serious risk to the patient’s life, or cause a serious functional decline. Examples of qualifying combinations are diabetes and hypertension and COPD and heart failure.
Does a chronic care management platform work with an existing EHR?
The majority of the existing platforms do integrate with popular EHR, but the level of integration varies widely from vendor to vendor. Some provide only one-way data export and others enable real time syncing of care plans and encounter notes. It is important to verify the depth of integration during a vendor demonstration and not rely on marketing materials to determine the extent of integration.
Does patient consent need to be obtained prior to initiating chronic care management billing?
Yes, CMS does require documented patient consent prior to the commencement of CCM services and consent must be redone annually. During the consent process the copay should be explained if applicable; CCM services would generally be cost shared by Medicare Part B as long as the patient does not have supplemental coverage. This consent is lost or not documented is one of the most frequent findings in CCM audits.
